Healthcare Provider Details

I. General information

NPI: 1184280158
Provider Name (Legal Business Name): MELISSA DANIELLE FLYNN RD/LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2019
Last Update Date: 01/11/2023
Certification Date: 01/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2421 SILVER STREAM LN
WILMINGTON NC
28401-7684
US

IV. Provider business mailing address

1202 MEDICAL CENTER DR
WILMINGTON NC
28401-7307
US

V. Phone/Fax

Practice location:
  • Phone: 910-362-8605
  • Fax: 910-251-3740
Mailing address:
  • Phone: 910-341-3300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL005321
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: